Search Results (303)

Background: Surgical interventions are complex and comprise multiple components, creating difficulties when considering how they might be described, standardised, and monitored (i.e., quality assurance) within randomised controlled trials (RCTs). Consolidated Standards of Reporting Trials – Non-Pharmacological Treatment (CONSORT-NPT) provides specific recommendations to improve the quality, transparency, and replicability of RCTs involving a surgical intervention. This structured narrative review explores and summarizes the reporting of quality assurance measures for surgical interventions in RCTs, using pancreatoduodenectomy (PD) as an exploratory case study. Methods: Searches for RCTs of PD were undertaken in PubMed, Medline, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from 2020 to 2024. Pancreatoduodenectomy (PD) was deconstructed into its constituent components (n = 40), and selected RCTs were scrutinised to explore reporting of quality assurance measures against the deconstructed components as described in CONSORT-NPT. Results: Of 189 screened articles, 37 RCTs were included, reporting on 5659 patients across 16 countries. No studies described all components of PD, and four did not report any components at all. Nine studies described some form of standardisation, and three measured adherence to standards, using intra-operative photographs. Minimum surgeon and centre volumes were specified in two and six trials, respectively. Conclusions: Quality assurance measures were poorly reported in selected RCTs involving PD, creating uncertainty in interpreting results. To enhance the design of future RCTs, a wider consensus regarding the core components of a PD is required. This will facilitate subsequent consideration of how these might need to be reported in future pancreatic surgical RCTs. Full article

Surgical resection remains the cornerstone of curative-intent therapy for colorectal liver metastases (CRLM). However, a substantial proportion of patients present with technically unresectable diseases or develop intrahepatic recurrence, despite optimal multimodal treatment. In this setting, liver transplantation (LT) has emerged as a potential strategy for durable, cancer-free survival in selected patients. Early experience with deceased donor liver transplantation (DDLT) for CRLM showed encouraging outcomes, but broader implementation has been constrained by ethical concerns and logistical barriers related to organ scarcity. Living donor liver transplantation (LDLT) offers a fundamentally different paradigm, potentially mitigating these limitations while introducing distinct technical, ethical, and logistical considerations. In this manuscript, we delineate the technical and logistic differences between DDLT and LDLT in the context of CRLM and highlight advantages unique to LDLT-based strategies. We contrast historical data with emerging contemporary evidence, with particular emphasis on LDLT outcomes. We critically examine evolving patient selection frameworks, incorporating molecular profiling and circulating tumor DNA-based liquid biopsy. In addition, we report our institutional experience with left lobe LDLT for CRLM in a patient who remains disease-free 30 months after transplantation. We conclude with a comprehensive appraisal of the current LDLT literature in CRLM and propose directions for future research. Full article

Background: Artificial intelligence is emerging as a promising tool in surgical oncology, with growing evidence suggesting potential applications in diagnostic support, intraoperative guidance, and perioperative risk assessment. In gastric cancer surgery, emerging applications range from AI-assisted endoscopic detection to data-driven perioperative risk prediction, while some technological developments, particularly in robotic autonomy, derive from broader surgical or experimental models that may inform future gastric procedures. Methods: A narrative review was conducted following established methodological standards, including the Scale for the Assessment of Narrative Review Articles (SANRA) and the Search–Appraisal–Synthesis–Analysis (SALSA) framework. English-language studies indexed in PubMed, Scopus, Embase, and Web of Science up to October 2025 were included. Evidence was synthesized thematically across five domains: AI-assisted anatomical recognition and lymphadenectomy support, autonomous robotic systems, early cancer detection, perioperative predictive and frailty models, and ethical and regulatory considerations. Results: AI-based computer vision and deep learning algorithms have demonstrated promising capabilities for real-time anatomical recognition, surgical phase classification, and intraoperative guidance, although evidence of direct patient-level benefit remains limited. In diagnostic settings, AI-assisted endoscopy and Raman spectroscopy have been shown to improve early lesion detection and reduce dependence on operator experience. Predictive models, including MySurgeryRisk and AI-driven frailty assessments, may support individualized prehabilitation planning and perioperative risk stratification. Persistent limitations include small and heterogeneous datasets, insufficient external validation, and unresolved concerns related to data privacy, algorithmic interpretability, and medico-legal responsibility. Conclusions: Artificial intelligence is progressively emerging as a promising tool in gastric cancer surgery, integrating automation, advanced analytics, and human clinical reasoning. Its safe and ethical adoption requires robust validation, transparent governance, and continuous surgeon oversight. When developed within human-centered and ethically grounded frameworks, AI can augment, rather than replace, surgical expertise, potentially advancing precision, safety, and equity in oncologic care. Full article

This case study presents a comparative analysis of real-world operation of two residential domestic hot water (DHW) preparation methods both connected to their own air-to-water heat pump (HP) located in Central Europe. One system employs a conventional configuration with separate tanks and an internal heating coil (HP-B), while the other features a compact tank-in-tank setup where DHW is heated via an integrated buffer tank (HP-A). Both systems were monitored under real operational conditions, with seasonal and annual coefficients of performance (COP, SCOP) calculated to evaluate efficiency. In the absence of complete thermal output data for one system, a reconstruction method based on the other’s performance and known heat losses was applied. The findings confirm that DHW system design significantly affects seasonal efficiency, particularly during summer operation when heating DHW dominates the energy load. The energy cost savings on heating during summer months could reach 44%. The tank-in-tank system showed higher electrical consumption and lower SCOP due to internal heat transfer dynamics and dual-function operation. The study further shows associated energy and cost differences and demonstrates a practical approach to comparing real-world systems offering insights for design optimisation and operational strategy. The authors of the article used the results of their research and experience from implementations as very effective feedback for further research and development. The novelty and uniqueness of the article lie in the energy comparison of two different connections of the hot water and heating water storage tanks with heat source systems using an “air-to-water” heat pump. The benefit of the solution in question is evident from the technical and economic evaluation. Full article

Background: Recent advances in multimodal therapies have increased the potential for resectability of borderline resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). We herein describe the conservative resection strategy adopted at our institution and the oncological outcomes of patients with PDAC and arterial involvement. Methods: This retrospective single-centre study included patients diagnosed with PDAC and radiologic evidence of arterial involvement who underwent surgical exploration between January 2014 and June 2024. All patients received induction chemotherapy (±radiotherapy). Survival outcomes were analyzed using the Kaplan–Meier and Cox proportional hazards models. Logistic regression analyses were used to identify predictors of resectability and recurrence. Results: A total of 76 patients were included: 59 underwent pancreatic resection with arterial divestment (AD) in case of persistent arterial involvement and 17 were deemed unresectable at laparotomy. Neoadjuvant folfirinox was significantly associated with increased odds of resection (HR = 3.23, 95% CI: 1.59–9.90, p = 0.040). Median overall survival from diagnosis was 33 months (29–39) in resected patients and 26 months (16–29) in non-resected patients (p = 0.0176). Surgical resection and Ca 19,9 normalization after induction therapy were associated with reduced mortality risk (HR = 0.38, 95% CI: 0.19–0.75, p = 0.005 and HR = 0.56, 95% CI: 0.35–0.88, p = 0.014, respectively). Conclusions: Despite a limited sample size and retrospective nature, these findings highlight the value of multimodal strategies in managing PDAC with arterial involvement. AD represents a valuable technique associated with acceptable outcomes in selected patients. Future interventional prospective studies are needed to optimize patient selection and validate the prognostic role of extended surgical procedures. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an increased risk of portal vein thrombosis (PVT), which may negatively affect post-liver transplant (LT) outcomes. We aimed to evaluate the impact of PVT on post-LT outcomes in MASLD versus non-MASLD recipients and assess outcomes in MASLD patients with PVT who received donation after circulatory death (DCD) grafts. Methods: Using the UNOS database, we analyzed adult LT recipients from 2002 to 2022. Kaplan–Meier and Cox regression models were used to assess one-year post-LT outcomes. Results: Among 46,933 LT recipients, 20% had MASLD (15% PVT prevalence) and 80% had non-MASLD etiologies (9% PVT prevalence). Overall, 3051 recipients (6.5%) received DCD grafts. PVT at the time of transplant was associated with significantly higher risks of all-cause mortality, graft failure, and death-censored graft failure (DCGF) in both MASLD and non-MASLD groups (p < 0.05), although no significant differences were observed between the two groups. In the DCD subgroup, MASLD recipients with PVT had a significantly higher risk of all-cause mortality compared to non-MASLD recipients without PVT (adjusted hazard ratio [aHR] 2.24, 95% CI 1.17–4.28, p = 0.01), but no differences were observed for graft failure or DCGF. Conclusions: PVT at the time of transplant is associated with poorer survival in MASLD and non-MASLD recipients. No difference was found between the two groups. In candidates receiving DCD grafts, the presence of PVT at time of transplant was associated with a marked increase in mortality risk, although this finding requires further validation in larger cohorts. Full article

Background: The optimal duration of neoadjuvant therapy for high-risk colorectal liver metastases (CRLM) remains debated. While prolonged chemotherapy may enhance response, it also increases toxicity and risks delaying potentially curative resection. These considerations have raised the question whether a short-course neoadjuvant strategy might achieve sufficient oncologic selection and response while minimizing treatment-related morbidity. Methods: Patients with synchronous or metachronous CRLM who received two cycles of neoadjuvant CAPOX plus bevacizumab followed by curative-intent liver resection treated between 2014 and 2024 at Health Network Vienna, Austria, were included. Clinicopathologic characteristics, treatment tolerability, response assessments (biochemical, radiologic, and pathologic), and survival outcomes were collected and analyzed. Results: A total of 57 patients were included (65% synchronous, 35% metachronous), with the rectum being the most frequent primary tumor site (45.6%). Most liver lesions were <5 cm (84.2%), and 47% had bilobar disease. Minor hepatectomy was performed in 65% of cases, predominantly via open surgery (72%). Grade ≥3 treatment-related adverse events occurred in 6 patients (10.6%), mainly neutropenia and diarrhea. Biochemically, 53.7% achieved >50% tumor marker reduction. Radiologic assessment showed partial response in 31.6% and complete response in 1.7%. Pathologic evaluation revealed TRG 3 as the most common finding (57.1%), followed by TRG 2 in 22.5%. Subgroup analyses demonstrated significantly improved OS and RFS in patients receiving adjuvant therapy and in those with tumors < 5 cm. Conclusion: A two-cycle, short-course regimen of CAPOX plus bevacizumab proved both effective and safe in high-risk CRLM, achieving meaningful biochemical, radiologic, and pathologic responses with acceptable toxicity. This abbreviated approach allowed delivery of neoadjuvant therapy while limiting cumulative treatment-related toxicity, supporting its feasibility as a neoadjuvant strategy in selected high-risk CRLM patients. Full article

Background/Objectives: Heterogeneity in clinical scenarios of colorectal liver metastases (CRLM) leads to the possible application of different surgical strategies. Specifically, the possibility of performing combined colorectal and liver resections for synchronous CRLM has been proposed in specific settings but its feasibility, safety and impact in minimally invasive settings remain underexplored. This study examines a multicenter Italian experience, comparing perioperative outcomes of combined (CR) versus non-combined (NCR) minimally invasive liver resections (MILR) for CRLM. Methods: Patients from the prospective multicenter registry of the Italian Group of Minimally Invasive Liver Surgery (I Go MILS) who underwent MILR for CRLM between 2016 and 2024 were included. Perioperative outcomes were compared between CR and NCR using Nearest Neighbor Matching. Results: In total, 2286 patients were analyzed, including 1879 NCR and 407 CR. CR was associated with less challenging resections (technical difficulty Kawaguchi grade III: 7.13% vs. 14.53%, p < 0.001), longer operative time (385 vs. 270 min, p < 0.001) and higher major complication rate (11.55% vs. 5.11%, p < 0.001) compared to NCR. The conversion rate was similar between the two groups (9.09% vs. 7.91%, p = 0.479). Technical complexity, operative time, conversion, low-volume hospital, and CR was an independent predictor of major complications after matching. Conclusions: CR is associated with a higher risk of postoperative complications, despite being selected for minor liver resections, confirming the impact of associated colorectal surgery in determining the postoperative risk and hence highlighting the concept that accurate preoperative patient selection is a key step in guiding treatment allocation for CRLM. Therefore, MILR does not yet justify broadening indications for combined resection beyond carefully selected patients. Full article

Alcohol-associated hepatitis (AH) is the most severe clinical manifestation of alcohol-associated liver disease. Corticosteroids are the only disease-specific therapy shown to improve short-term survival. Currently, no non-invasive markers are available to predict patient response to corticosteroids or long-term survival in AH. This study investigates whether surface antigens on plasma extracellular vesicles (EVs), key mediators of intercellular communication, can reflect the underlying immune dysregulation in AH and serve as prognostic markers. Patients with AH were prospectively enrolled between 2020 and 2024. Blood samples were collected before corticosteroid initiation during the first 24 h of hospitalization. EVs were characterized using nanoparticle tracking analysis, cryo-electron microscopy, and flow cytometry. Interleukin-6 (IL-6), soluble (s)CD62p, Circulating Vascular Cell Adhesion Molecule-1 (sVCAM), tumor necrosis factor receptor superfamily member 1 (TNRFS1a), and Intercellular Adhesion Molecule 1 (ICAM-1) were quantified by ELISA. Key outcome variables included response to corticosteroids and mortality. A total of 46 patients with AH and 28 healthy donors (HD) were included. EV concentration was significantly higher in AH patients than in HD (9.3 × 10¹¹ [IQR 4–24] versus 2.4 × 10¹¹ [IQR 2–4], p = 0.03). Specific EV antigens were associated with key clinical outcomes: CD20 and CD2 levels differed between patients with or without infections (bacterial, viral, and fungal) developed during hospitalization; CD40 and CD146 were elevated in patients who developed acute kidney injury. EVs enriched in monocyte (CD14) and T-reg (CD25) markers were associated with plasma IL-6 levels, while endothelial markers CD105 and CD146 correlated with sVCAM and sCD62p. EVs enriched in platelet (CD49e) and endothelial (CD31) markers were associated with corticosteroid response, whereas EVs enriched with endothelial (CD105 and CD146) and B lymphocyte (CD19) markers were associated with mortality. Overall, EVs enriched in endothelial and monocyte markers may represent a candidate non-invasive tool for predicting corticosteroid response and mortality in AH, aiding risk stratification and early identification of non-responders for timely transplant evaluation. Full article

Objective: Although non-hepato-pancreato-biliary (non-HPB) cancer, such as gastric and colorectal cancer, may cause biliary obstruction, the efficacy of endoscopic transpapillary drainage remains unclear. We investigated the clinical outcomes of endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer. Methods: This was a two-center retrospective observation study. We evaluated the technical success, clinical success, recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and overall survival (OS). OS was determined using the Kaplan–Meier method, and the significance was tested using the log-rank test. Cox regression hazard models were performed to identify the independent association of clinical parameters with OS. Results: This study included 43 cases. The technical success was achieved in all cases (100%), and the clinical success was achieved in 35 cases (81%). The occurrence rate of RBO and non-RBO AEs were 33% and 12%, respectively. The median TRBO was 176 days. Systemic chemotherapy was introduced in 17 cases (40%) after biliary drainage, and cases with the introduction of systemic chemotherapy had a significantly longer OS. C-reactive protein <3.4 mg/dL and biliary obstruction due to lymph node metastasis were independently associated with the introduction of systemic chemotherapy. In survival analysis, serum albumin >3.1 g/dL and the introduction of systemic chemotherapy were significant and independent predictive factors for the prolongation of OS. Conclusions: The endoscopic transpapillary drainage for biliary obstruction due to non-HPB cancer can provide favorable outcomes with appropriate patient selection. Full article

Background/Objectives: Despite the long-standing history of liver transplantation (LT) in Spain, no multicenter study has reviewed national outcomes for LT in metastatic neuroendocrine tumors (NETs). In the current era of transplant oncology, auditing these results is essential to refine patient selection and improve long-term outcomes. Methods: This retrospective observational study analyzed data from 13 centers, including 91 patients who underwent LT for NET between 1995 and 2024. Patients were stratified into two groups: Milan IN (those meeting the Milan criteria) and Milan OUT (the remainder). Results: Recurrence occurred in 57.1% of cases, and overall mortality was 51.6%. Of the 91 patients, 71 (78.0%) were Milan IN and 20 (22.0%) were Milan OUT. Five-year overall survival was 71.0% in Milan IN and 58.0% in Milan OUT, with a statistically significant difference. The 5-year disease-free survival (DFS) rate was 58.8% in Milan IN and 36.3% in Milan OUT; this difference was not statistically significant. Conclusions: In conclusion, strict adherence to Milan criteria and incorporation of modern prognostic factors are critical to optimize long-term survival in LT for NET. While the overall outcomes in this historical cohort are modest, future improvements are expected through more rigorous selection and the potential use of bridging or downstaging therapies. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is now recognized as the leading cause of chronic liver disease worldwide. MASLD spans a spectrum ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH) and is linked to progressive fibrosis and ultimately hepatocellular carcinoma (HCC). Growing evidence implicates cellular senescence (CS) and lipid droplets (LDs) as key drivers of disease progression, although their interaction remains poorly characterized. This review provides an integrative and stage-dependent synthesis of current mechanistic insights into how bidirectional crosstalk between CS and LD regulation shapes the transition from steatosis to MASH. Senescent hepatocytes display altered lipid metabolism, including upregulation of receptors such as cluster of differentiation (CD) 36, enhancing lipid uptake to meet increased energy demands. Initially, elevated free fatty acid influx can activate peroxisome-proliferator-activated receptor alpha (PPARα), promoting fatty acid oxidation (FAO) as a compensatory response. Over time, persistent CS under steatotic conditions leads to mitochondrial dysfunction and suppression of fatty acid oxidation (FAO), while the senescence-associated secretory phenotype (SASP), largely driven by nuclear factor—kappa B (NF-κB) signaling, promotes chronic hepatic inflammation. By framing LDs as active modulators of senescence-associated signaling rather than passive lipid stores, this review highlights how disruption of senescence–lipid feedback loops may represent a disease-modifying opportunity in MASLD progression. Full article

Background: Multimodal AI integration across genomics, radiomics, and pathomics is rapidly evolving in oncology, but evidence remains heterogeneous and unevenly distributed across modalities. Objective: To map empirical studies integrating two or more -omic modalities, summarize integration and validation approaches, and identify gaps informing future directions toward surgomics. Methods: We conducted a scoping review in accordance with PRISMA-ScR, searching PubMed, Ovid, Wiley Online Library, and Google Scholar for English-language studies published from January 2020 to 5 March 2025. We charted study characteristics, modalities combined, fusion strategies, AI model categories, validation approaches, and reported performance metrics as presented by the original studies. Results: From 184 records, 11 studies met inclusion criteria (n = 1078 total participants across reported studies), most focusing on radiomics–pathomics integration; fewer incorporated genomics, and tri-modal fusion was uncommon. Studies varied widely in clinical tasks, endpoints, preprocessing, and validation, limiting direct comparability. Conclusions: The mapped evidence indicates growing methodological activity in radiopathomics and cross-scale association modeling, while tri-modal pipelines and clinically deployable multimodal workflows remain underdeveloped. Surgomics is presented as a conceptual, staged roadmap informed by these gaps rather than a current clinical capability. Full article

The clinical management of Pancreatic Neuroendocrine Neoplasms (Pan-NENs) is complicated by the disease’s intrinsic variability, which creates significant hurdles for accurate risk profiling and the standardization of treatment protocols. Recently, Artificial Intelligence (AI) has offered a promising avenue to address these challenges. By integrating and processing high-dimensional multimodal datasets (encompassing clinical history, radiomics, and pathology), these computational tools can refine survival forecasts and support the development of personalized medicine. However, the transition from experimental success to routine clinical use is currently obstructed by reliance on limited, retrospective cohorts that lack external validation, alongside unresolved concerns regarding algorithmic transparency and ethical governance. This review evaluates the current landscape of AI-driven prognostic modeling for Pan-NENs and critically examines the pathway towards their reliable integration into clinical practice. Full article

Background: Hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT) has a poor prognosis, and the benefits of neoadjuvant therapy are unclear. This systematic review and meta-analysis aim to evaluate the impact of neoadjuvant treatment (NAT) followed by surgery versus surgery alone on survival outcomes. Methods: A PRISMA-compliant systematic review was conducted by searching the OVID databases Embase, Medline, PubMed, and Scopus for English-language comparative studies of resectable HCC with PVTT, up to 23 January 2025. Two reviewers independently screened, extracted data, and assessed risk of bias (ROBINS-I/ROB2). Hazard ratios (HRs) for overall survival (OS) and recurrence-free survival (RFS) were pooled for meta-analysis. Results: Seven studies (2015–2024, five retrospective cohorts, one non-randomised comparative, one RCT) included 621 patients. The pooled analysis demonstrated that NAT followed by surgery was associated with a significantly improved OS (HR: 0.48, 95% CI: 0.295–0.67, p-value < 0.001, I² = 0.00) and improved RFS (HR: 0.4, 95% CI: 0.2–0.58, p-value < 0.001, I² = 0.00). Conclusions: For patients with HCC and an associated PVTT, neoadjuvant treatment before surgery significantly improves both overall and recurrence-free survival. These findings support a multimodal approach. Current evidence is largely non-randomised and HBV-endemic, warranting prospective validation in aetiologically diverse cohorts, including Western ones. Full article